The aging of anorexia:Middle-aged women—and older—fight the devastating disease

By Lorna Collier
Special to the Chicago Tribune
When she was 35, Gwen wanted what many women want: to lose 10, maybe 20
pounds.

Not that the Chicago homemaker and community activist was fat. But
she'd had five kids in 15 years, leaving her with about 155 pounds on
her 5-foot-9-inch frame. Though her husband never complained, she felt
flabby and unattractive.

Gwen started by cutting out fats and junk food and exercising
regularly. During the following year, she began taking off the pounds,
and the experience—the control over her body, the compliments she
received—thrilled her.

Then her dieting and exercise began to escalate. She stopped eating
almost entirely, weighed herself repeatedly each day, exercised
compulsively and eventually dropped to a skeletal 100 pounds.

Gwen had developed anorexia nervosa.

"I could not believe this was happening," says Gwen, who asked that her
real name not be used. Now 46, she was hospitalized eight times for the
disorder before she recovered. "I argued with my therapist. I said,
`This happens to young girls, to college-age girls. It does not happen
to grown women in their 30s with five children who have a life.' "

But, in fact, anorexia and other eating disorders among older women—in their 30s, 40s, 50s and beyond—are not uncommon and, according to
some experts, are increasing.

"There is a misconception that this is primarily or exclusively an
adolescent or college women's issue," says Claire Mysko, administrative
director of the American Anorexia/Bulimia Association in New York City.
But, Mysko says, "we are definitely seeing older women -- more and more
so."

No statistics exist to show how many women 30 and over have eating
disorders. At the Center for the Study of Anorexia and Bulimia in New
York City, about a quarter of the patients are over 30, while the
majority of the people in support groups run by the National
Association of Anorexia Nervosa & Associated Disorders in Highland
Park are 30 or older.

About 8 million Americans suffer from eating disorders, with about 86
percent first seeing symptoms by age 20. The condition is often
chronic; patients who don't recover and who don't die from their
illness continue to experience symptoms into their middle years and
even into retirement age.

"Anorexia nervosa in the elderly is just becoming recognized," says Dr.
Stanley Coren, a psychiatrist at the University of British Columbia who
has studied anorexia deaths in nursing homes. "I believe that with the
increasing age of the population, we will be seeing more cases of older
anorexia sufferers."

Older women with eating disorders fit into three categories: those who
have struggled with the disorder since their teens; those who had an
early occurrence, but recovered and remained symptom-free until later
years; and those whose symptoms first cropped up well past their teen
years. Experts also say older women are more likely to be bulimic -- to
binge and purge, either through vomiting or through the use of
laxatives -- than they are to be anorexic.

Gwen had suffered from anorexia for a year when she was 15, but had not
had significant symptoms after that until she fell ill at 35.

Shelley Sokol, on the other hand, is a 42-year-old suburban Chicago
woman who has been battling anorexia since she was 17.

Her 25-year bout with the illness has left her with osteoporosis so
severe that she has shrunk in height from 5 feet 6 1/2 inches to 5 feet
4 inches. She has broken a hip, been hospitalized three times, seen her
weight drop as low as 66 pounds, and now suffers from liver problems,
swollen ankles, dizziness, fatigue and depression. Married for 18
years, she has never been able to have children. Last year, she had to
leave her job as a buyer for a manufacturing firm because of her
disability.

"Now there's so much help out there (for girls with anorexia)," says
Sokol, who believes if she had received better treatment as a teen that
she would not still be caught in anorexia's grip today.

Dr. Anne Becker, director of research at Harvard Medical School's
Eating Disorders Center, says older patients who have been struggling
with the disorder for a long time can be very difficult to help.

"Many of these women have had symptoms for a number of years that have
gone unaddressed," Becker says. "It can be very hard to break the cycle
once it's been an old friend for 5 or 10 or more years."

Kathy Jones, a schoolteacher in Pennsylvania, had a different
experience: She had never had any symptoms of anorexia until she was 35
and trying to deal with the break-up of a relationship. Jones, now 43,
says she was so grief-stricken over her lost love that she decided to
kill herself by starvation.

However, three months later, the decision to die had faded, while the
desire to lose weight had become all-consuming.

"Dying was on the back burner," Jones says. "Once you start losing
weight, it was like a runner's high, like this real challenge. `Can I
lose 5 pounds in the next two days?' I would weigh myself constantly to
make that goal. If I couldn't take control of my life in this
relationship, then by God I was going to take control of my body."

Jones, who has been hospitalized four times, now weighs about 90
pounds, up from a low of 75, but much less than the 125 she weighed
before her illness began. She still finds it impossible to eat much
more than vegetable broth, pretzels and sugar-free Popsicles.

"One of the big gaps in our treatment of anorexia is that there are
almost no treatment studies to tell us what to do with older patients,"
says Dr. Daniel Le Grange, assistant professor of clinical psychiatry
at the University of Chicago and director of the university's eating
disorders program.

Bates, Sokol and Jones say they have been frustrated during their
treatment by what they perceive as a lack of support for mature
patients.

"While in-patient, I was always the oldest one on the floor," Bates
says. "In group therapy, I was often in groups with young women who
were the ages of my students. I never have felt really comfortable
sharing my problems with girls so much younger than me."

Gwen had a similar experience while hospitalized.

"Unfortunately, the fact remains that most of the people in eating-
disorder programs are young kids, so you are going to be with young
kids. It became hard for me to relate to them. I felt like they were my
kids; I'm sure they looked at me like I was their mother and were
wondering, `What are you doing here?' "

She would have liked to have met more women her age with her problem,
so that she would not have felt so alone.

"For me, it was very shameful," Gwen says. "Here I was, a woman in her
late 30s, and I had this horrible, horrible problem. People looked at
you; you were treated terribly by other people. I was so ashamed that I
had an illness that primarily strikes young girls. I still feel
ashamed."

Mysko says she would not be surprised to see treatment programs
developed soon that will focus strictly on the needs of older women,
who often have children and jobs to contend with, and who may be
struggling with midlife crises.

"For some women, the aging process is very traumatic," Mysko says.
"They feel anxiety at getting older and don't feel they can accept
themselves in our culture. We live in a culture that is very obsessed
with weight, with a narrow ideal of beauty, which means being young and
being thin."

Sharlene Hesse-Biber, a Boston College sociologist and author of "Am I
Thin Enough Yet?"(Oxford University Press, $13.95), argues that eating
disorders can in large part be blamed on our current weight- obsessed
society, in which older women are expected as never before to achieve
youthful figures -- to look as fabulous at 40 as Christie Brinkley, as
fit at 50 as Cher.

"The pressure is to be a certain kind of body in this culture," she
says. "The impact of being in the wrong kind of body is devastating, at
any age. You are not absolved from the cult of thinness at menopause."

Many experts, however, don't think that eating disorders can be blamed
entirely -- if at all -- on society's emphasis on thinness. Most say
the disorder is extremely complex and is caused by multiple factors,
from family stresses to biological predisposition to personality type.
However, dieting can precipitate eating disorders in some people, says
Dr. Regina Casper, a Stanford University psychiatrist and leading
eating-disorders researcher.

Gwen has been recovered from her anorexia for the last four years. Her
turning point came, she says, when she realized that she had to choose
between living and dying. "I decided I wanted to live. I have a life, a
marriage, five incredible kids."

She also believes she has forever freed herself from caring about
having a perfect, model-thin body.

"So what if you're a 14 or a 16 or an 18? Big deal. What is really the
crime in it? We're taught we have to look a certain way, but I don't
care much any more. I really don't.

"I am at peace with myself."

SIDEBAR: THE IMPACT OF A PARENT'S
ANOREXIA

Mothers with eating disorders often worry that they will somehow pass
their illness on to their children.

"This is a very, very serious concern," says Claire Mysko,
administrative director of the American Anorexia/Bulimia Association in
New York. "We are finding that eating-disordered behavior and concerns
about fat and weight are filtering into a younger and younger populace
because we have mothers who are not OK."

A recent study published in the International Journal of Eating
Disorders concluded that mothers with eating disorders interacted
differently with their children when it came to feeding and weight
concerns than did other mothers, suggesting that "the risk factors for
later development of an eating disorder may begin very early in life."

However, other studies have shown more mixed results, and doctors still
don't know enough about eating disorders to say what causes them in
anybody, whether in the mother or her child.

"I don't think parents cause anorexia nervosa," says Dr. Daniel Le
Grange, assistant professor of clinical psychiatry at the University of
Chicago and director of the university's eating disorders program. "I
always tell parents we have no evidence to suggest that, but we don't
fully understand the heritability of eating disorders." Le Grange says
current research into the possibility of an "anorexia gene" is still
under way.

When Gwen, a Chicago homemaker who asked that her real name not be
used, developed anorexia at age 35, she had five sons, ranging in age
from 4 to 16. She didn't have problems feeding them, but they were
nevertheless quite affected by her illness.

"It was very, very devastating for my kids," she says. "I was a real
anchor for them; I was very close to them. They cried a lot when I went
into the hospital."

Her sons never developed eating disorders themselves, but as a
consequence of her illness, "they are not interested in real skinny
girls and they don't like people who don't eat."

Dr. Susan P. Sherkow has been concerned enough about how eating
disorders in mothers affect their children that, five years ago, she
started the Eating Disorders Therapeutic Nursery in New York. Her
program is aimed at helping eating-disordered mothers with small
children, ages 5 and under.

Sherkow, an expert in infant development, began the center in 1995,
after caring for a baby who was losing weight. She discovered the
infant's mother couldn't feed the child properly because she was
anorexic and the sight of solid food repulsed her.

Sherkow brings groups of such women and their young children together
for therapy and for meals. She has treated one family for four years;
the oldest child, now 7, has already shown signs of bulimia, which
Sherkow says the child developed after observing the behavior in her
mother.

Not all mothers with eating disorders find it difficult to feed their
children, experts say. Many love to feed their families but will avoid
eating any of the meals themselves.

John Mead, a psychologist who co-directs the Eating Disorders Unit at
Rush Presbyterian St. Luke's Medical Center in Chicago, believes the
best way to ensure a child does not develop an eating disorder is
through the development of a strong, attached relationship.

"If the mother has had poor parenting herself and she's had trouble
establishing a secure attachment with her offspring," he says, "then
she's at risk for creating an eating disorder."